Observations on urban motherhood, current events and anything else that sparks my imagination.

Friday, August 13, 2010

A rational fear

One of my favorite people had a baby a couple of weeks ago. Hers was one of those smooth, uncomplicated deliveries, and I'm pleased to report that mom and baby are doing just fine. Nothing noteworthy there, right? Except that, about a month before the birth, A. mentioned that she was really, really scared about the impending blessed event.

I think it took a fair amount of guts for her to say that out loud.

In this day and age of over-sharing, where some women even post the gruesome details of their labors in real time on Facebook (aside- if I haven't seen you in fifteen years, please don't send me updates on your cervix), a few topics still feel taboo. Fear of childbirth is one of them, and I'm not sure why, because either mode of infant exit still strikes me as a big deal, wherein lots of things could go wrong. True, most births turn out fine, but a substantial minority of moms experience some type of complication. It seems crazy, especially in our litigious society, not to address some of the common issues in advance, and discuss what should or will happen if they arise.

I live in a city that boasts some of the world's finest hospitals, and yet I know many women who were very unsatisfied with their birth experiences. The most common complaint I've heard is from women who have gone through hours and hours of labor before their physicians agreed to perform a cesarean. This is ridiculous and shouldn't be happening. A cesarean is major surgery that many women hope to avoid. BUT if it looks like the medically reasonable way to go, why go into the procedure already exhausted and traumatized by a labor that's going nowhere? Another common hindsight comes from women who chose natural childbirth, but who didn't have the benefit of the intensive classes that were popular a few decades ago, when natural was all the rage. They wish their doctors had impressed upon them the need to prepare, beyond reading a book and taking the odd yoga class.

Without seeking them out, I've met women who have lost so much blood they needed multiple transfusions; had vaginal deliveries that left them facing multiple surgeries to restore continence; undergone sloppy episiotomies that left them unexpectedly crippled for weeks; received wholly unrealistic timetables for recovery; had cesarean incisions re-opened and re-sewn due to infections and pain; suffered a prolapsed uterus. They had one thing in common: they were all left a bit bitter because their doctors had been almost dismissive of these outcomes. "My OB was like, you have a healthy baby, so stop whining," the friend who had SIX surgeries to restore her urinary tract told me. It was basically a continuation of the attitude that fear of birth isn't worth discussing.

As much as women of all ages seem to relish any chance to share their birthing stories, our culture expects us to embrace childbirth as a beautiful, natural thing. If you can do that, I'm really happy for you. Lots of us can't, for reasons physical, emotional or both. And I don't think it's a crazy fear: somewhere on the planet, a woman dies every 30 seconds in childbirth. Why? Because it's inherently dangerous, especially in a non-hospital setting.

Women in the first world don't die in childbirth in huge numbers anymore, although in the United States, the number is on the rise for the first time since the 1970s. (The media seems to like to blame obesity and advanced maternal age for the disturbing trend, but I suspect that it also has something to do with the fact that many women on the lower rungs of the socio-economic ladder just don't get proper medical care. Otherwise maternal mortality would be on the upswing in other Western countries, where moms-to-be are also older and fatter than they were thirty years ago.)

Obstetricians obviously don't want to terrify their patients. However, in my experience, and in those of many friends, the doctors tended to be too dismissive of patients' birthing-related phobias, to the point that women learn to keep these fears private. I don't think that's necessarily healthy. Many pregnant women already feel emotionally volatile and physically tired. They shouldn't be made to feel badly because they're scared of a major impending event - even if it's one they've enthusiastically signed up for. Nor should they be made to feel like a pest if they ask a lot of questions, compose written plans and medical instructions, or choose to voice an opinion on their care once in the hospital.

I think A. was smart to articulate her fears. I think many more women would do the same, if asked in a way that invited conversation. But the reality of the big city baby catching business is that it's kind of a factory. When I needed to see my OB once on a same-day basis, her assistant told me I'd be the 50th patient on the schedule that day. "15th?" I asked, to make sure. "No. 50th. Five-zero." Unless you're prepared to be demanding, and arrive at your appointments armed with an agenda, most doctors who work at that pace are not going to check in with every expectant mom on her mental state. It's too lucrative to check the mom's blood pressure and the fetal heartbeat and move along to the woman in the next room. True, some women opt for midwives for precisely this reason, but it's not an option for women like A., whose pregnancy was categorized as high risk.

So next time an imminently due close friend seems nervous, go ahead and ask if she's worried about the birth. And more importantly, if she says yes, please don't do any of the following: roll your eyes, launch into one of those dreadful "it's-a-miracle-and-a-gift-and-the-pain-is-so-worth-it" speeches, or tell her to man up. Pregnancy is exhausting enough without the pressure to pretend that all is wonderful if it's not.

As for my friend A., I'm delighted her particular fears went unrealized, because now I can tell her: Welcome to Mommy Land!!! It's an incredible ride.